Stop-TB eCorrespondent: 28 July - 17 August 2009

Stop-TB eCorrespondent
Issue 49
28 July - 17 August 2009

TOP five tuberculosis (TB) related-news items from the past week

Direct and indirect costs of TB among immigrants is of concern

Researchers assessed the direct and indirect costs of immigrants with TB in the Netherlands. Average direct costs spent by households with a TB patient amounted Euros 353. Most costs were spent when being hospitalized. Time loss (mean 81 days) was mainly due to hospitalization (19 days) and additional work days lost (60 days), and corresponded with a cost estimation of Euros 2603. Researchers concluded: Even in a country with a good health insurance system that covers medication and consultation costs, patients do have substantial extra expenditures. Furthermore our patients lost on average 2.7 months of productive days. TB patients are economically vulnerable. Read more...

Clinton strikes agreement with drug companies for AIDS, TB treatments

Recent agreements between the Clinton Foundation's HIV/AIDS Initiative (CHAI), Pfizer and the Mylan subsidiary Matrix will make it a little easier for people in the developing world to get the AIDS and tuberculosis medicines they need. The treatment regiment will be made available for less than USD 475 a year when the drugs are bought separately. The drug regiment will be made available to governments that are members of the foundation's Procurement Consortium. Read more...

Antibiotic overuse creating more drug-resistant TB

Medical experts are saying the overuse of a common antibiotic may be reducing its effectiveness as a defense against tuberculosis. Fluoroquinolones are the most commonly used class of antibiotic in the US. They're effective against a wide range of infections and against TB infections that show drug resistance. Read more...

99% of MDR-TB patients got drug-resistant TB strains from someone who was already infected with drug-resistant TB

The study found that most resistance is not a direct result of treatment failure but a result of transmission of the disease from initial treatment failure, ABC News reports. "We found 99 percent of cases are due to transmission from somebody else who had a resistant strain," said Andrew Francis, one of the study researchers from the University of Western Sydney. Read more...

Dramatic reduction in AIDS and non-AIDS morbidity and mortality: report

Evidence presented at the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention, demonstrated dramatic reductions in TB and malaria incidence in people living with HIV (PLHIV). Universal provision of antiretroviral therapy (ART) to PLHIV would have a major impact on reducing HIV transmission, in addition to keeping people alive, well and productive in their communities. Read more...

TB AND HIV NEWS HIGHLIGHTS FROM TB HIGH-BURDEN COUNTRIES in the past week

(To read the TB profile of the high-burden countries below, click on the name of the country)

Brazil

One-third of TB cases go un-detected: WHO

A new TB vaccine could be ready by 2016

NGOs are equal partners with governments in TB control

Fighting TB stigma using a community-based approach

Involving TB patients in TB programmes will help

Zimbabwe

HIV prevalence dips but TB rates go up

Neglected health crisis on farms

Zimbabwe figures in TB report show grim picture

A distortion of foreign aid to Africa

Uganda

Public demand for mobile TB screening

Buhinga regional referral hospital in TB management dilemma

Climate change effect on TB and HIV

SMS for HIV and TB family messages

Make a phone call and test for TB: future of mobile phones

The challenge of initiating TB clubs in schools

Churches and healers claim to cure HIV and TB

Mother to child TB effect: The unnoticed threat

Treatment of tuberculosis using fluoroquinolone

Shortage of medicines cripple Uganda's health system

South Africa

Diabetes ups TB risk among children and adolescents

Dramatic reduction in AIDS and non-AIDS morbidity and mortality: report

Journalists step up in the fight against HIV, TB and Malaria

TB Vaccine research stepped up further with new collaboration

Disruption in HIV drug supplies and funding endanger people's lives

Collaboration to conduct TB vaccine trial in PLHIV

TB vaccine (BCG) risky for children living with HIV/AIDS

Tanzania

Novartis reaffirms its commitment to TB control

Global Fund to fight AIDS, TB and Malaria (GFATM) grants USD 680 million to Tanzania (Round 8)

Weak health systems, poverty, AIDS fuel TB

Nigeria

TMC207: Promising new drug for tuberculosis

Will public-private mix improve TB response in Nigeria?

150,000 TB deaths in Nigeria annually

Need to scale up response to TB-HIV co-infection

Government neglect is the cause of high TB rate

Democratic Republic of Congo

TB patients' groups are strengthening TB responses in Congo

India

Diarrhoea, TB more deadly in India than swine flu (H1N1)

Call for coordination between AIDS and TB programmes

Drug-resistant TB strains are equally transmissible just like drug-sensitive strains

TB control programme schemes need greater flexibility

TB diagnosis in just 30 minutes

Vietnam

TB is the top health issue in Vietnam

Vietnam is gearing up to respond to MDR-TB

Russian Federation

Lilly MDR-TB Partnership helps four hardest hit MDR-TB countries access drugs

One-fifth of Russia's TB hospitals lack running water

Russia agrees to release ex-Yukos Chief who is living with HIV-TB co-infection

Only 9% of TB hospitals meet hygienic standards

Kenya

Kenyan court jails man for spreading MDR-TB

TB time-bomb ticks as state runs out of cash

Why Kenya still shoulders high burden of TB?

Stigma rife for MDR-TB patients in Kenya

Myanmar

Political prisoner dies of TB

China

Interventions are needed for smoking cessation among TB patients

TB threat shouldn't hold up adoptions from China

An old scourge returns

Student pilot from China in hospital with tuberculosis

Indonesia

Financial crisis poses new challenge for AIDS and TB (ICAAP 2009)

Indonesia gets USD 25 million from GFATM to fight TB (ICAAP 2009)

Universal Access: challenges in the Asia-Pacific region (ICAAP 2009)

Insufficient sputum quality results in missing TB cases

Philippines

Two people with asthma and TB died of swine flu in Philippines

Who is at a higher risk of Swine Flu virus in Philippines?

Children at high risk of TB in Philippines' province

Bangladesh

Eight people die of TB each hour in Bangladesh

Social mobilization and awareness can strengthen TB care and control

Raising awareness about TB care is vital in Bangladesh

Pakistan

TB outbreaks in camps - a new worry in Pakistan

How to treat drug resistant non tuberculous mycobacteria?

Pakistan's refugees of its 'war on Taliban' fill up a TB-hospital

Public awareness and health promotion can help eradicate TB

Thailand

Healthcare workplaces do increase the risk of Latent TB in healthcare workers: study

Integrating services for HIV, TB and drug users

WHO grants funding for TB research

Cambodia

Business as usual will thwart TB control

Financial crisis demands innovative solutions to control TB

Winner of the Images to Stop TB Award announced at Angkor Photography Festival

Afghanistan

DOTS coverage upped from 38% to 97% in five years

Ethiopia

Teacher with MDR-TB continues to teach: can't afford treatment

WHAT'S HAPPENING

6-10 September: European conference on Tropical medicine and International health, Italy

9-12 September: Second Regional Conference of The Union (IUATLD) in Asia-Pacific, Beijing, China

22-25 September: 5th Annual Meeting of Clinton Global Initiative, New York, USA

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Stop-TB eCorrespondent is produced by Stop-TB eForum Resource Team, Health & Development Networks(HDN)

SMS helpline for Free TB support service in India

SMS helpline for Free TB support service in India

A Short-Message-Service (SMS) helpline was launched in New Delhi, India to provide round-the-clock free tuberculosis (TB) support service to TB patients. This SMS helpline is being managed by ex-TB patients.

Earlier on World Health Day (7 April 2009), a unique partnership was forged in a community of India's capital to improve TB responses (read more). The residents of south Delhi and healthcare providers in this area participated in an open dialogue to identify key challenges that people faced in accessing the health services, and came up with effective solutions that can potentially improve the quality of care for all residents. This new Community Care Club in the Lado Sarai area of South Delhi (India), has been working to improve the health of people in the diverse district by bringing together consumers and care-providers in a dynamic 'partnership in health'. Led by local former TB patients and people living with HIV (PLHIV), this is an initiative to empower not only themselves, but also to empower and mobilize a broad base of the community including the private and public sectors.

The SMS helpline was launched in another follow-up meeting of Community Care Club on 26 May 2009. Breaking new ground, from the bottom up, people living with the diseases and those most affected had reached out to raise the standards of care, driving forward on securing their Rights and fulfilling their Responsibilities, as outlined in the Patients' Charter for Tuberculosis Care.

The World Care Council, an international NGO of activists living with HIV and/or TB, is beginning to roll out a series of projects in India. As TB is the greatest killer of PLHIV, and almost half a million Indians die annually from this curable disease, the World Care Council is striving to build a mechanism for empowerment for all those either with TB or most at risk, applying many lessons learned from the last 25 year of HIV/AIDS activism and other social movements.

Over the last few months, the World Care Council's Indian branch has organized patient support groups, trained a team of TB activists to get local Clubs going, and conducted Outreach for Input events to build stake-holding on the ground in two pilot projects in New Delhi and Goa, with the support of the United States Agency for International Development (USAID). The first seeds for growing social mobilization have been planted, nurtured and are ready to blossom. Now, the outreach is underway to forge dynamic partnerships with key elements of civil society and to strengthen existing collaborations with the Revised National TB Control Programme (RNTCP), National AIDS Control Organization (NACO) and State Governments.

On 26 May 2009, a meeting was held in the LRS Institute of Tuberculosis and Respiratory Diseases, New Delhi, and on 27 May 2009, another meeting was held in Lado Serai Community Hall in South Delhi.

These series of meetings are particularly important because for the first time in the history of India's TB control efforts, the TB patients themselves are taking centre-stage in driving mobilization and advocacy for scaling up TB care to improve services and prevention for themselves, their peers and their neighbours.

The Revised National Tuberculosis Control Programme (RNTCP) of the Government of India, now includes the Patients' Charter for Tuberculosis Care (PCTC, The Charter). The Charter is also a part of the global Stop TB Strategy, and lays out the rights and responsibilities of people with TB, and how the Charter is a tool to effectively achieve the implementation of the International Standards of Tuberculosis Care (ISTC).

However, implementing the Charter on the frontlines of TB care, raising awareness about rights and responsibilities, and using it as an empowering tool for people with TB and their community in order to improve the quality of care services, is certainly a daunting task.

The SMS helpline managed by ex-TB patients is certainly a step forward in responding effectively to the challenge. The SMS helpline number is (0) 99710 43320.

- Bobby Ramakant, HDN Key Correspondent

Critical reforms of IMF policies demanded

Critical reforms of IMF policies demanded

Earlier this month the Group of Twenty (G-20) leaders had announced a USD 1.1 trillion booster-dose into the world economy by the end of 2010 through multilateral institutions like the International Monetary Fund (IMF). Health advocates believe that critical reforms are needed for IMF policies to prevent disastrous fallouts like rising tuberculosis (TB) incidence in countries that might receive IMF funding.

In July 2008, analysts from Cambridge and Yale Universities had reported that tuberculosis (TB) in countries with IMF loans rose sharply. The strict conditions on IMF loans were blamed for thousands of extra TB deaths in Eastern Europe, and former Soviet republics. A UK TB charity backed the Public Library of Science (PLoS) study findings - but the IMF had firmly rejected them, as per a BBC news (July 2008).

David Stuckler from Cambridge University had said to BBC in July 2008 that "If we really want to create sustainable economic growth, we need first to ensure that we have taken care of people's most basic health needs."

The BBC news further said that "in recent years, it [IMF] has offered assistance to 21 countries in the region, in the form of loans offered in exchange for the meeting of strict economic targets. The researchers claimed it was efforts to meet these targets that were undermining the fight against TB by drawing funding away from public health."

Most striking was the analysis in BBC news that "without the IMF loans, they suggested, rates would have fallen by up to 10%, meaning at least 100,000 extra deaths. Countries which accepted IMF loans averaged an 8% fall in government spending, a 7% drop in the number of doctors per head of population, and a fall in a method of TB treatment called "directly observed therapy", which is recommended by the World Health Organisation."

The Treatment Action Group (TAG) is mobilizing civil society from around the world to endorse a letter before 23 April 2009 to demand that the final proposals must include critical reforms of IMF policies that will enable increased investments in health and education.

As an outcome of the G-20 meeting in London on 2 April 2009, the Declaration called on the IMF to come up with "concrete proposals" for the allocation of these additional resources during the Spring Meetings of the World Bank and IMF planned for 25-26 April 2009 in Washington DC, USA.

The civil society letter calls upon the IMF's International Monetary and Financial Committee and the World Bank-IMF Development Committee as well as any IMF committee tasked with developing proposals to fulfill on the G-20 commitment, to ensure the following reforms are incorporated in the final proposal:

- The IMF must phase out those activities outside its areas of core competence such as those of the Poverty Reduction and Growth Facility (PRGF). The IMF does not have a mandate for, or competence in, the long-term development of low-income countries. IMF resources channeled through the PRGF and from the proceeds of gold sales should support grant assistance or debt relief and be directed to an appropriate aid mechanism. The IMF's Policy Support Instrument (PSI) should also be phased out, in order to end the IMF's monopoly on 'signaling' to donors whether or not developing countries warrant support.

- The IMF must eliminate harmful conditions linked with its loan programs and other instruments. The IMF should end its tradition of requiring countries to implement contractionary policies in economic recessions. For instance, the IMF should ensure that expanded investment in health and education are not subjected to overall budget caps and that subsidies that cushion the impact of the crisis on poor people are not eliminated. The IMF has made progress toward eliminating wage bill ceilings as conditions for lending, but it should stop this practice entirely. In addition, the IMF should stop directing countries to engage in privatization of services or financial sector liberalization through its loans and other instruments.

Organizations from around the world are endorsing this civil society letter and let's hope that IMF will listen to these sane voices.

World Health Day: Make hospitals safe in emergencies

World Health Day: Make hospitals safe in emergencies

The World Health Day (7 April 2009) focuses on the safety of health facilities and the readiness of health workers who treat those affected by emergencies. Health centres and staff are critical lifelines for vulnerable people in disasters - treating injuries, preventing illnesses and caring for people's health needs.

They are cornerstones for primary health care in communities – meeting everyday needs, such as safe childbirth services, immunizations and chronic disease care that must continue in emergencies. Often, already fragile health systems are unable to keep functioning through a disaster, with immediate and future public health consequences.

This year, the World Health Organization (WHO) and international partners are underscoring the importance of investing in health infrastructure that can withstand hazards and serve people in immediate need. They are also urging health facilities to implement systems to respond to internal emergencies, such as fires, and ensure the continuity of care.

Particularly in low and middle-income countries, the heavily burdened health systems with raging epidemics and limited health facilities and trained healthcare workers, often fuel the debate between strengthen health systems and single-disease vertical interventions. However the role of strong and robust health systems, which are well funded, resourced and have adequate skilled human resource to provide services to all those who need it, is certainly a vision that the world is striving to achieve.

Even in developed countries like USA, data reveals on how access to healthcare remains a privilege and is often beyond the reach of the most underserved communities.

The paradigm shift will occur when communities that seek healthcare services, are treated with dignity as equal partners along with healthcare workers in improving health systems. It is honestly not only a clinical or medical issue. The genuine partnership between healthcare workers and communities based on equity, dignity and respect, will certainly radically improve the quality and accessibility of healthcare services.

Will IMF deliver G-20's booster for world economy?

Will IMF deliver G-20's booster for world economy?

Earlier this week the Group of Twenty leaders announced a USD 1.1 trillion booster-dose into the world economy by the end of 2010 through multilateral institutions like the International Monetary Fund (IMF). However, in July 2008, analysts from Cambridge and Yale Universities had reported that tuberculosis (TB) in countries with IMF loans rose sharply.

The strict conditions on IMF loans were blamed for thousands of extra TB deaths in Eastern Europe, and former Soviet republics. A UK TB charity backed the Public Library of Science (PLoS) study findings - but the IMF had firmly rejected them, as per a BBC news (July 2008).

David Stuckler from Cambridge University had said to BBC in July 2008 that "If we really want to create sustainable economic growth, we need first to ensure that we have taken care of people's most basic health needs."

Most alarming was when the levels of drug-resistant TB shot up in eastern Europe and former soviet union.

The BBC news further said that "in recent years, it [IMF] has offered assistance to 21 countries in the region, in the form of loans offered in exchange for the meeting of strict economic targets. The researchers claimed it was efforts to meet these targets that were undermining the fight against TB by drawing funding away from public health."

Most striking was the analysis in BBC news that "without the IMF loans, they suggested, rates would have fallen by up to 10%, meaning at least 100,000 extra deaths. Countries which accepted IMF loans averaged an 8% fall in government spending, a 7% drop in the number of doctors per head of population, and a fall in a method of TB treatment called "directly observed therapy", which is recommended by the World Health Organisation."

It is not surprising that healthcare doesn’t get the mandate at forums like G-20 in the manner in which it should. Before the G-20 began, there was a growing public movement globally to put pressure on G-20 countries to put a currency transaction levy of 0.005% to raise dedicated resources for funding health programmes. This currency transaction levy of 0.005% can potentially generate USD 30-40 billion a year.

It is vital to understand the health funding in these times of global economic meltdown. The single largest donor of AIDS, TB and Malaria programmes globally - the Global Fund to fight AIDS, TB and Malaria (GFATM) has just 37.5% of its estimated budget for 2009-2010. The donor countries haven’t kept their promises to fund the 'Fund'. The GFATM projected budget for 2009-2010 was USD 8 billion and it just has USD 3 billion in its kitty, falling short of USD 5 billion.

The donor countries that haven’t kept their promises include the United States of America that is also the biggest defaulter. It is not that US doesn’t have money, it gave about the same amount it owed to GFATM to Merrill Lynch as bail out money. It gave hundreds of times more to other private banks as bail out money. The banks distributed this amount amongst themselves as 'holiday bonuses'.

Another example comes from one of the most severely TB-HIV hard-hit regions - Africa. Despite of African governments declaring TB as an emergency, Africa as a region, faces the largest funding gap of USD 10.7 billion to fully implement the Global Plan to Stop TB by 2015.

The countries in Africa had achieved a milestone by endorsing the African Union Abuja pledge of allocating 15% of national budgets to health but they have bitterly failed to act on this pledge. Only Botswana has kept the promise of allocating 15% of the national budget to health, the rest of the countries in Africa need to keep their promises.

As per a report of the World Bank and Stop TB Partnership (December 2007), high-burden TB countries are likely to recover 9-15 times of their investment in TB control. This report indicates that the economic cost of not treating TB to Africa between 2006 and 2015 would be USD 519 billion while TB can be controlled with USD 20 billion in the same period.

It is clear that despite evidence, health is not perceived as a smart investment. Possibly imposing currency transaction levy of 0.005% can generate a pool of dedicated financial resources to strengthen health systems globally.

It is high time to be clear on what kind of a development we want for the world - a model which serves the capital interests of corporations or a model which serves the most basic needs for all, including that of healthcare?

One good analysis which further highlights this debate is from India. The Indian Prime Minister Dr Manmohan Singh gave indications of his shaking confidence in neo-liberal economic policies of liberalization- privatization-globalization in India in two meetings of Confederation of Indian Industries (CII). "He suggested that CEOs must consider placing voluntary ceilings on their salaries. He said that the gap between the rich and poor would produce social unrest. He said that for an unemployed youth a 9% growth rate didn’t mean anything. He added that CEOs must not treat their wealth for personal consumption only but should consider using it for general good of society. He invoked the much forgotten ‘trusteeship principle’ of Mahatma Gandhi, which probably no politician in independent India has ever mentioned. Now, these thoughts would make a very sound policy if the objective was to create a humane and equitable society instead of elevating the growth rate" said Dr Sandeep Pandey, Ramon Magsaysay Awardee (2002) and a National Alliance of People's Movements (NAPM) leader.

Are G-20 leaders listening?

People with drug-resistant tuberculosis (TB) are neglected by governments

People with drug-resistant tuberculosis (TB) are neglected by governments

The countries that report high burden of tuberculosis (TB), particularly, drug-resistant strains of TB, are the ones not moving fast enough to provide life saving treatment. According to the International medical humanitarian organization, Medecins Sans Frontieres (MSF) or doctors without borders, less than one percent of those with multi-drug resistant TB (MDR-TB) get access to proper treatment as per the International standards of treatment and care guidelines of World Health Organization (WHO). Even the Stop TB Partnership agrees that about three per cent of those with MDR-TB might be receiving proper treatment.

"Only 3% of people who have MDR-TB have access to effective treatment. We have compelling evidence that we know how to prevent and treat MDR-TB and treatment success rate is 80% in low resource setting. Its intervention is complex but is effective, feasible and is cost-effective" stressed said Dr Ernesto Jaramillo, Medical Officer, Stop TB Department, World Health Organization (WHO) at the 3rd Stop TB Partners' Forum in Rio de Janeiro, Brazil.

Dr Mario Raviglione, Director of the WHO's Stop TB department, said that "the WHO Global Tuberculosis Control Report 2009 confirms the notion that there might be more than half a million MDR-TB cases every year. 54 countries have reported extensively drug-resistant TB (XDR-TB) to us."

As ministers from high-burden multi- and extensively- drug-resistant TB (M/XDR-TB) countries gather from 1-3 April 2009 in Beijing, China, for a high-level ministerial meeting on M/XDR-TB, MSF calls on them to commit to treating more people with MDR-TB, and to conducting necessary research to improve current treatment options.

The WHO reports that there are more than 500,000 new MDR-TB cases each year, but that under 30,000 people were detected and notified last year and only 3,681 are known to have started treatment according to international guidelines and with quality-assured medicines.

“The slow progress in treating people with MDR-TB is particularly striking because high-burden MDR-TB countries are definitely not the least developed in the world,” said Dr. Tido von Schoen-Angerer, Director of MSF’s Access to Essential Medicines Campaign. “They have the capacity to act, and need to make this a priority and put people on treatment.”

MSF is concerned that many countries, particularly those that are classified by WHO as ‘high-burden’, like China, South Africa or India, are not doing enough to provide treatment to patients in need. In addition, not providing appropriate treatment further contributes to the spread of drug-resistant TB.

China, for example, has a quarter of the world’s MDR-TB cases. Answering to an initial request made by the Chinese National TB Programme, MSF then failed to obtain the authorisation to provide care for MDR-TB patients in inner Mongolia, despite two years of negotiations with national, provincial and regional authorities. MSF has now abandoned its attempts to open the project.

“Not being able to act when there are people that need life-saving treatment is extremely frustrating,” said Meinie Nicolai, MSF Director of Operations. “Because we did not manage to reach an agreement, we could not put a single patient on treatment. And because they can’t get treated anywhere else, many people will have died while we were stalled in meetings these past two years.”

“Crucially, high-burden countries have the skills and some of the resources needed to conduct the research to improve MDR-TB treatment,” says Dr. von Schoen-Angerer. “The Beijing meeting is an opportunity for high-burden countries to take the lead in addressing this crisis, by setting targets to put more patients on treatment, by agreeing to import quality-assured drugs, and by establishing a joint research effort to improve existing treatment.”

In 2007, MSF treated 574 patients for MDR-TB in 12 projects including in South Africa, India, Uzbekistan, Georgia and Armenia.

According to the World Health Organization (WHO), the countries with the highest burden of MDR-TB are India (131,000 cases), China (112,000), Russia (43,000), South Africa (16,000) and Bangladesh (15,000).

The High Level Ministerial Meeting on M/XDR-TB is being organized by WHO, the Ministry of Health of the People's Republic of China and the Bill and Melinda Gates Foundation.

This meeting is likely to bring together health ministers and other stakeholders from 27 high M/XDR-TB burdened countries, including justice and science ministry delegations and representatives from international agencies, civil society, research communities and the corporate sector.

"We have been able to convince the ministers of health of 27 high burden M/XDR-TB countries to come to the Beijing meeting and commit to achieve the targets of the Global Plan to Stop TB" said Dr Ernesto Jaramillo, Medical Officer, Stop TB Department, WHO at the 3rd Stop TB Partners' Forum in Rio de Janeiro, Brazil.

"The 2nd Global Plan to Stop TB which was launched in 2006 had laid out specific targets for MDR-TB, to provide universal access to diagnosis and treatment of MDR-TB by year 2015" said Dr Jaramillo.

The 27 countries represented will be Armenia, Azerbaijan, Bangladesh, Belarus, Bulgaria, China, the Democratic Republic of Congo, Estonia, Ethiopia, Georgia, India, Indonesia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, the Republic of Moldova, Myanmar, Nigeria, the Philippines, the Russian Federation, Pakistan, South Africa, Tajikistan, Ukraine, Uzbekistan and Viet Nam.

The highest levels of MDR-TB ever recorded were reported by WHO in its 'Anti-tuberculosis Drug Resistance in the World' report in February 2008 with nearly half a million new MDR-TB cases emerging worldwide. According to the new WHO report (Global Tuberculosis Control report 2009), the levels of multi-drug resistant TB might be more than half a million as previously thought.

The threat of MDR-TB and XDR-TB can be halted but few of the 27 high MDR-TB burdened countries have response plans in place. Many of these countries are not even properly equipped to diagnose drug-resistant TB.

"We need political commitment from the countries. The XDR-TB task force had met in April 2008 in order to assess the progress we had made in response to MDR-TB and XDR-TB. The Task Force came up with lot of positive things, major progress in many areas. However the number of people on treatment was far below the target. One of the clear recommendations coming out of the XDR-TB Task Force meeting was to convene a high level ministerial meeting where we can get ministers of countries responsible for the 85% of the global M/XDR-TB burden, to achieve the target of universal access to diagnosis and treatment of MDR-TB by 2015" explained Dr Jaramillo.

Countries with low resources are building their capacities to make things happen. Lesotho was able to make a state-of-the-art laboratory for diagnosis of MDR-TB in six months. "We have countries like Nepal, Philippines, Peru that despite of weakness in health systems are providing universal access to MDR-TB diagnosis and treatment" said Dr Jaramillo.

"So far the Green Light Committee (GLC) mechanism, which is an initiative of WHO, and has played an instrumental role in leading the response, began with only one country in the year 2000 - Philippines. Now 8 years later we have 58 countries that have 116 projects approved by GLC. However we have less than 20% of countries that are moving towards scale up country wide of these interventions" said Dr Jaramillo.

Dr Jaramillo expressed his concern that "Countries are not moving fast enough in order to prevent the death of 1000 people with MDR-TB every day."

Vice Premier of China, the Director-General of WHO and very likely that Bill Gates and ministers of health confirmed so far from 21 high burden M/XDR-TB countries will be taking part in the Beijing meeting opening next week.

"We are expecting that this will be a watershed meeting in response to M/XDR-TB" said Dr Jaramillo.

"After this meeting we will like to move towards a World Health Assembly (WHA) resolution. The resolution of WHA is powerful in the sense that countries really commit to do things. After the Beijing meeting, one month later, the Government of China has agreed to submit a proposal of a resolution to the WHA in order to accelerate the response to M/XDR-TB" shared Dr Jaramillo.

Investing in research is also necessary. Treating MDR-TB is complex, lengthy and involves the use of drugs that can cause severe side effects and are not optimally effective. There is therefore an urgent need to speed up the development of newer, better tests and drugs, and to conduct studies to optimise MDR-TB treatment.

Neglect of TB control among indigenous communities unethical

Neglect of TB control among indigenous communities unethical

The need to include indigenous people in the Global Plan to Stop TB was echoed by many participants at the 3rd Stop TB Partners' Forum in Rio de Janeiro, Brazil (23-25 March 2009).

"We demand inclusion of indigenous peoples in the Global Plan to Stop TB strategy and have launched a strategic framework aimed at addressing tuberculosis among indigenous peoples. The Stop TB Strategy builds on the successes of directly observed treatment shortcourse (DOTS) while also explicitly addressing the key challenges facing TB. Its goal is to dramatically reduce the global burden of tuberculosis by 2015" said Wilton Littlechild, Regional Chief, Assembly of First Nations.

There are approximately 370 million indigenous peoples globally in more than 70 countries. Although programmes have been designed to combat TB, indigenous populations globally have been left out of such efforts due to cultural barriers, language differences, geographic remoteness, and economic disadvantage. TB rates among indigenous people are consistently higher than general public. During the five year period 2002-2006, the first nations TB rate was 29 times higher than others born in Canada - for the Inuit, it was 90 times higher. Pacific islanders and Maoris are 10 times more likely to contract TB than other people living in New Zealand. In Kalaallit Nunaat, Greenland, residents have a risk rate more than 45 times greater than Danish born citizens.

"These challenges will not be easily met - but they can be met by ensuring indigenous peoples are true partners in global TB control. We have a comprehensive and achievable plan to stop indigenous TB globally, but to realize our goal we need support" said Chief Littlechild.

Indigenous people have a consistent pattern of health inequality across a variety of jurisdictions from resource poor to the resource rich. Indigenous health inequalities are multi-faceted, and are both social and political in nature.

"Indigenous leaders will continue to work with the United Nations Permanent Forum on indigenous issues, the World Health Organization (WHO) and the Stop TB Partnership in addressing indigenous TB globally" further added Chief Littlechild.

Highlighting the problem of TB treatment default and risk of developing drug-resistant forms of TB in indigenous people, Chief Littlechild said that "we wish to establish a secretariat to collect data of TB programmes in indigenous communities. Due to a broad range of reasons, indigenous people aren’t able to access TB-related treatment and care services and if they are, then they are more likely to default, increasing the risk to develop drug resistance" said Chief Littlechild. With the High Level Ministerial meeting on multi- and extensively- drug-resistant TB (M/XDR-TB) going to open in Beijing, China (1-3 April 2009) later this week, it is indeed a clear message from indigenous communities for their Health Ministers to commit to responding to their specific issues regarding TB control.

In response to another question, Chief Littlechild said that "human rights based approach calls for genuine partnership and indigenous communities can be part of the solution."

The inequities faced by indigenous communities are much severe than in general population. "Countries like Canada report that poverty has gone down but poverty in indigenous communities has gone up. In prisons too there are a significant number of indigenous communities. There are host of other life conditions that put these people at an elevated risk of infectious diseases like TB - overcrowded housing and lack of access to safe drinking water are just few of those challenges" said Chief Littlechild.

The strategic framework to control TB among indigenous populations was developed through consultations with indigenous leaders, TB experts and health advocates from over 60 countries. It is designed to take an indigenous approach that links the right to health, education, housing, employment, and dignity. It is based on equality of opportunity to the highest level of health attainable world wide. It will serve as a tool to build a social movement to raise awareness of indigenous TB, to develop targets and messages, to pilot interventions and to monitor TB trends among indigenous peoples. An important component to this framework calls upon indigenous peoples to demand access to TB prevention and treatment measures in their communities.

- Bobby Ramakant